Thursday, May 7, 2009

Borderline Personality Disorder Awareness


In honour of May being Borderline Personality Disorder Awareness Month,
The American Journal of Psychiatry has a few well written articles on the subject.

In an editorial by Oldham, attention is brought to the amygdala (my favourite brain part) and brain structure and function affecting borderline patients.

It is interesting that, although we now recognize the importance of heritable risk factors
predisposing a patient to develop borderline personality disorder, the evidence-based
core treatment recommended for this disorder is psychotherapy, an intervention
long thought to change the mind but not necessarily the brain. Ironically, we also now
understand that intensive psychotherapy is a form of long-term learning and memory,
which indeed changes the brain. Psychotherapy is thus, at least in part, a biological
treatment. But one important emphasis here is the reference to “long-term.”

It is encouraging and refreshing to hear that attitudes towards BPD patients are shifting from labeling one as a difficult patient to a more empathic understanding of their early traumas and inherent predispositions to relationship instability. It is also encouraging to know that mental health professionals are willing to undertake the lengthy journey of recovery with borderline patients, and in doing so providing them with a stable secure relationship. I think the next step in BPD treatment now is to see if we can find ways to speed up the recovery process. This will of course save governments many dollars, but more importantly, it will save borderline patients possibly years of instability and uncertainty. As well, a more efficient treatment will mean patients will complete their therapy and a therapist will also be able to see more patients. This is an obvious statement, but one we should keep in mind as new treatments, pharmacological and psychotherapeutic, are being developed.

On a slightly related note, we often hear in the world of psychiatry how much opinions have changed. A very good thing indeed, but I myself grow weary of constantly having to defend the efficacy of psychiatric treatments and the tolerance and support of those suffering with mental illnesses; shouldn’t we be beyond that by now? Tireless though it may be, continued vociferous education is critical to the ongoing development of social and professional empathic healing.

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